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COVID-19 - recommendations for laboratory work

29 March 2020

The IBMS, in collaboration with professional bodies RCPath, ACP and ACB, have issued joint guidance on the prioritisation of pathology testing during the COVID-19 pandemic

The guidance has been approved by NHS England and NHSI as a guide to prioritisation of resources during this time of unprecedented emergency. The clinical input has been collated and coordinated by Jo Martin, President of the Royal College of Pathologists (RCPath) with input from the IBMS, Association of Clinical Biochemistry and Laboratory Medicine (ACB) and the Association of Clinical Pathologists (ACP).

Aims and objectives

Pathology services must be in a position to continue to support clinical services over the coming difficult period. Many laboratories have already reviewed their work in order to safeguard core services whilst moving to minimal staffing levels to promote resilience and social distancing. This document outlines a range of measures that laboratories can use to prioritise work, to release staff, facilities, equipment and reagents to cope with the viral outbreak and maximise SARS-CoV-2-19 testing capacity.

There is significant unwarranted variation in laboratory testing, identified by the Getting it Right First Time Programme. A reduction in non-essential testing, and unnecessary testing, is a pre-requisite to release staff, and should be implemented without delay.

In general, tests which are not essential to managing a patient’s condition safely should be stopped. For example, mild infections can often be treated empirically without the need for confirmatory microbiology. Many other laboratory tests can be deferred. This document provides a guide for local tests that could be high priority for review, and laboratories can use this document to provide the necessary permission to accelerate these decisions.

Plans should be made to explore the potential for multi- disciplinary working within pathology and utilising staff from other areas (in a support role) to ensure service continuity.

All laboratories should review the measures outlined in this document and undertake a local review of activities. Where appropriate, but within a competency framework, flexibility of staff between the different disciplines should be reviewed locally.

Recommendations

The guidance sets out 20 recommendations that should be considered urgently, by all Pathology Laboratory and Clinical Pathology providers, working with primary care, community and acute care providers, including NHS and Public Health England.

Cancer Screening ProgrammesSymptomatic cases to be prioritised as usual, whilst all Cancer screening programmes for breast, bowel and cervical cancer to be deferred and HPV screening capacity to be diverted to a smaller number of centres.

Genomics testingThe genomics implementation unit has issued guidance for the prioritisation of testing

Routine andrology testingRoutine infertility testing of semen should be deferred for 3-6 months in the first instance whilst post vasectomy testing of semen should be continued.

Turnaround times for batch testingCertain specialist tests and batch tests which could, with minimal risk, move to less frequent testing. Laboratories should review the possibility of consolidating more complex tests on fewer sites.

Lab to Lab electronic connectivity Connecting labs to avoid repeated data entry and data transcription and allowing end to end transmission of results to patient records is a priority.

The guidance also contains an assessment that each of the recommendations is likely to have on the laboratory workforce and patients.

Allan Wilson, IBMS President, said:

"It is vital to provide our members with the guidance they need to continue to support clinical services during the COVID-19 pandemic. I am grateful to Jo Martin, President of the Royal College of Pathologists, for leading on this guidance document and proud of the contribution the Institute has made.

Producing this information in a short period of time, is testament to the close working relationship we have with other laboratory professional bodies. I hope that you find this guidance helpful and please do share with laboratory colleagues everywhere"

Whilst these recommendations have been agreed by the Pathology and Laboratory Medicine professional bodies, local Pathology Laboratories are asked to review their current local practices and if other local services can be reduced and refined then a local assessment should take place.